Pathway from Functional Disability to Antimicrobial Resistance in Nursing Homes

描述（由申请人提供）：抗菌素耐药生物（AROs）是疗养院（NH）的地方病，患病率超过医院。在ARO获得（和传播）过程中，残疾宿主、机构环境和护理人员接触之间的相互作用这一基本问题仍未得到解答。我们假设NH居民的特定日常生活活动（ADL）残疾模式将预测获得风险或新的AROs。我们将研究残疾和感染风险是否与医护人员接触时间和接触强度成正比。我们提出的具体目标是：目标1：开发和检验一个风险分层模型，利用居民、HCW和环境层面的因素来确定NH居民的三类：(1)从未获得ARO；(2)间歇获取ARO；(3)新获得一个ARO并持续被殖民。住院水平的因素包括ADL损伤的增加水平和特定模式、伤口的存在和留置装置的使用。HCW因素包括接触时间和接触强度，以及护理资源利用的不同程度。环境因素包括居住房间、公共区域和康复室的无生命物体上存在AROs。我们还将建立一种“分子指纹”，在功能受损居民和那些与环境隔离的人以及护理人员手中的AROs菌株之间进行鉴定。利用这种风险分层模型，我们将在风险最高的功能性残疾NH居民中建立最佳的ARO预防策略。目的2：设计和评估多成分干预的有效性，以减少高风险功能性残疾NH居民AROs的新获得。这种干预将包括居民

DESCRIPTION (provided by applicant): Antimicrobial-resistant organisms (AROs) are endemic in nursing homes (NH) with prevalence rates surpassing those in hospitals. The basic question of interaction between a disabled host, institutional environment, and caregiver contact in ARO acquisition (and transmission) remains unanswered. We hypothesize that specific activities of daily living (ADL) disability patterns in NH residents will predict acquisition risk or new AROs. We will examine whether disability and risk of acquisition are proportional to healthcare worker contact time and contact intensity. Our proposed Specific Aims are: Aim 1: Develop and examine a risk-stratification model utilizing resident-, HCW-, and environmental-level factors to identify three categories of NH residents: (1) never acquire an ARO; (2) intermittently acquire an ARO; and (3) newly acquire an ARO and remain persistently colonized. Resident-level factors include incremental levels and specific patterns of ADL impairment, presence of wounds, and use of indwelling devices. HCW factors include contact time and intensity, as well as varying levels of nursing resource utilization. The environment factors include presence of AROs on inanimate objects in resident rooms, common areas, and rehabilitation rooms. We will also establish a "molecular fingerprint" between the strains of AROs colonizing functionally-impaired residents and those isolated from their environment and the hands of caregivers. Using this risk-stratification model, we will establish the optimal ARO prevention strategy in highest-risk functionally-disabled NH residents. Aim 2: Design and evaluate the effectiveness of a multi-component intervention to reduce new acquisition of AROs in the highest-risk functionally-disabled NH residents. This intervention will incorporate resident level, environmental, and caregiver-based strategies. The proposed translational study is innovative and timely because it will develop a risk-stratification model to identify functionally-disabled NH residents who are most likely, if colonized, to transmit AROs; define a molecular "fingerprint" of resident-caregiver-environment ARO contamination; and design and implement a multi-component comprehensive intervention targeting high-risk functionally-disabled residents. The impact of this research will be an effective, efficient, and infection prevention program for NHs to limit ARO acquisition and more importantly transmission. We expect our results to have widespread application in NHs, enhance residents' quality of life, reduce hospital transfers, reduce healthcare costs and shift the evolving paradigm of infection control and prevention in NHs.